Impact of a goal-directed factor-based coagulation management on thromboembolic events following major trauma
Abstract Background A factor-based coagulation management following major trauma is recommended as standard of care by the European Trauma Treatment Guidelines. However, concerns about the thromboembolic risk of this approach are still prevalent. Our study therefore aims to assess if such a haemosta...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-12-01
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| Series: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13049-019-0697-0 |
| _version_ | 1818666501417205760 |
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| author | Anais L. Stein Julian Rössler Julia Braun Kai Sprengel Patrick E. Beeler Donat R. Spahn Alexander Kaserer Philipp Stein |
| author_facet | Anais L. Stein Julian Rössler Julia Braun Kai Sprengel Patrick E. Beeler Donat R. Spahn Alexander Kaserer Philipp Stein |
| author_sort | Anais L. Stein |
| collection | DOAJ |
| description | Abstract Background A factor-based coagulation management following major trauma is recommended as standard of care by the European Trauma Treatment Guidelines. However, concerns about the thromboembolic risk of this approach are still prevalent. Our study therefore aims to assess if such a haemostatic management is associated with an increased risk for thromboembolic events. Methods In this retrospective observational study carried out at the University Hospital Zurich we compared two three-year periods before (period 1: 2005–2007) and after (period 2: 2012–2014) implementation of a factor-based coagulation algorithm. We included all adult patients following major trauma primarily admitted to the University Hospital Zurich. Thromboembolic events were defined as a new in-hospital appearance of any peripheral thrombosis, arterial embolism, pulmonary embolism, stroke or myocardial infarction. A logistic regression was performed to investigate the association of thromboembolic events with possible confounders such as age, sex, specific Abbreviated Injury Scale (AIS) subgroups, allogeneic blood products, and the coagulation management. Results Out of 1138 patients, 772 met the inclusion criteria: 344 patients in period 1 and 428 patients in period 2. Thromboembolic events were present in 25 patients (7.3%) of period 1 and in 42 patients (9.8%) of period 2 (raw OR 1.39, 95% CI 0.83 to 2.33, p = 0.21). Only AIS extremities (adjusted OR 1.26, 95% CI 1.05 to 1.52, p = 0.015) and exposure to allogeneic blood products (adjusted OR 2.39, 95% CI 1.33 to 4.30, p = 0.004) were independently associated with thromboembolic events in the logistic regression, but the factor-based coagulation management was not (adjusted OR 1.60, 95% CI 0.90–2.86, p = 0.11). Conclusion There is no evidence that a goal-directed, factor-based coagulation management is associated with an increased risk for thromboembolic events following major trauma. |
| first_indexed | 2024-12-17T06:05:32Z |
| format | Article |
| id | doaj.art-e5f0134814eb4d509dcdde22e9e6e4e7 |
| institution | Directory Open Access Journal |
| issn | 1757-7241 |
| language | English |
| last_indexed | 2024-12-17T06:05:32Z |
| publishDate | 2019-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| spelling | doaj.art-e5f0134814eb4d509dcdde22e9e6e4e72022-12-21T22:00:46ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412019-12-012711710.1186/s13049-019-0697-0Impact of a goal-directed factor-based coagulation management on thromboembolic events following major traumaAnais L. Stein0Julian Rössler1Julia Braun2Kai Sprengel3Patrick E. Beeler4Donat R. Spahn5Alexander Kaserer6Philipp Stein7Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of ZurichInstitute of Anaesthesiology, University and University Hospital ZurichDepartments of Biostatistics and Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of ZurichDepartment of Trauma, University and University Hospital ZurichDepartment of Internal Medicine, University Hospital ZurichInstitute of Anaesthesiology, University and University Hospital ZurichInstitute of Anaesthesiology, University and University Hospital ZurichInstitute of Anaesthesiology, Cantonal Hospital WinterthurAbstract Background A factor-based coagulation management following major trauma is recommended as standard of care by the European Trauma Treatment Guidelines. However, concerns about the thromboembolic risk of this approach are still prevalent. Our study therefore aims to assess if such a haemostatic management is associated with an increased risk for thromboembolic events. Methods In this retrospective observational study carried out at the University Hospital Zurich we compared two three-year periods before (period 1: 2005–2007) and after (period 2: 2012–2014) implementation of a factor-based coagulation algorithm. We included all adult patients following major trauma primarily admitted to the University Hospital Zurich. Thromboembolic events were defined as a new in-hospital appearance of any peripheral thrombosis, arterial embolism, pulmonary embolism, stroke or myocardial infarction. A logistic regression was performed to investigate the association of thromboembolic events with possible confounders such as age, sex, specific Abbreviated Injury Scale (AIS) subgroups, allogeneic blood products, and the coagulation management. Results Out of 1138 patients, 772 met the inclusion criteria: 344 patients in period 1 and 428 patients in period 2. Thromboembolic events were present in 25 patients (7.3%) of period 1 and in 42 patients (9.8%) of period 2 (raw OR 1.39, 95% CI 0.83 to 2.33, p = 0.21). Only AIS extremities (adjusted OR 1.26, 95% CI 1.05 to 1.52, p = 0.015) and exposure to allogeneic blood products (adjusted OR 2.39, 95% CI 1.33 to 4.30, p = 0.004) were independently associated with thromboembolic events in the logistic regression, but the factor-based coagulation management was not (adjusted OR 1.60, 95% CI 0.90–2.86, p = 0.11). Conclusion There is no evidence that a goal-directed, factor-based coagulation management is associated with an increased risk for thromboembolic events following major trauma.https://doi.org/10.1186/s13049-019-0697-0Coagulation managementCoagulation factorsThromboembolic eventsTransfusionTrauma |
| spellingShingle | Anais L. Stein Julian Rössler Julia Braun Kai Sprengel Patrick E. Beeler Donat R. Spahn Alexander Kaserer Philipp Stein Impact of a goal-directed factor-based coagulation management on thromboembolic events following major trauma Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Coagulation management Coagulation factors Thromboembolic events Transfusion Trauma |
| title | Impact of a goal-directed factor-based coagulation management on thromboembolic events following major trauma |
| title_full | Impact of a goal-directed factor-based coagulation management on thromboembolic events following major trauma |
| title_fullStr | Impact of a goal-directed factor-based coagulation management on thromboembolic events following major trauma |
| title_full_unstemmed | Impact of a goal-directed factor-based coagulation management on thromboembolic events following major trauma |
| title_short | Impact of a goal-directed factor-based coagulation management on thromboembolic events following major trauma |
| title_sort | impact of a goal directed factor based coagulation management on thromboembolic events following major trauma |
| topic | Coagulation management Coagulation factors Thromboembolic events Transfusion Trauma |
| url | https://doi.org/10.1186/s13049-019-0697-0 |
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